Provider Demographics
NPI:1669353553
Name:MARTI, PAULA DIANE (CPM)
Entity type:Individual
Prefix:
First Name:PAULA
Middle Name:DIANE
Last Name:MARTI
Suffix:
Gender:F
Credentials:CPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18707 COUNTY ROAD 4110
Mailing Address - Street 2:
Mailing Address - City:ROLLA
Mailing Address - State:MO
Mailing Address - Zip Code:65401-7107
Mailing Address - Country:US
Mailing Address - Phone:573-202-8178
Mailing Address - Fax:
Practice Address - Street 1:18707 COUNTY ROAD 4110
Practice Address - Street 2:
Practice Address - City:ROLLA
Practice Address - State:MO
Practice Address - Zip Code:65401-7107
Practice Address - Country:US
Practice Address - Phone:573-202-8178
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-09
Last Update Date:2025-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife